The Medicare Rural Hospital Flexibility Program (Flex Program) was established through the Balanced Budget Act of 1997 and then later revised through the Balanced Budget Refinement Act (BBRA), the Benefits Improvement and Protection Act (BIPA), and the Medicare Modernization Act (MMA). This program aims to improve access to preventive and emergency health care services for rural populations. Providing federal grant funding to 45 eligible States (excluding Connecticut, Delaware, Maryland, New Jersey and Rhode Island), the Flex Program requires states to develop a CMS approved state rural health plan and conduct planning for improving rural health networks. The Flex Program also puts significant effort into designating Critical Access Hospitals (CAHs) in each state and aiding hospitals in determining if conversion to CAH status is the right choice based on eligibility criteria and financial returns.